Introducing OSCE for stomatology education in Georgia: Tbilisi State Medical University experience

Authors

Prof. Marina Mamaladze
MD. PhD.
Prof. Nino Korsantia
MD. PhD.

Theme

OSCE and Standard Setting

Category

OSCE

INSTITUTION

Department of Odontology,Tbilisi State Medical University

Background

   Organization of the examination and exam tests preparation (or tickets) for the students of the Faculty of Dentistry (as well as the Faculty of Medicine) are related to the certain specifications. Assessment of the student's knowledge in a given subject should include his/her theoretical knowledge and clinical competencies/ skills.

   Our main goal was achievement maximal refining of the style of final exam at the Department of Odontology (III, IV, VI, VII and X semesters of study process). That is why, the OSCE (Objectively Structured Clinical Examination) type of examination system was chosen.

Conclusion

 

   At TSMU Department of Odontology the OSCE exam has been held since 2009; the experience gained for that period of time showed that: 

·            First of all the process of examination was not stressful for the students of III, IV, VI and VII semesters. It should be noted that in case of face to face examination, the student's reaction might be inadequate, due to feeling discomfort to reveal his / her knowledge properly. 

·      

Take-home Messages

 

   The OSCE type examinations were accepted positively by the students. Implementation of the OSCE examination would be comfortable as for the students as well as for academic personnel, however, material - technical support from the University would be needed.

   Maximum objectivity of the examination reduces the doubts concerning to results of examination among the students and what is the most important it is designed to reveal the efforts, knowledge, experience and aspirations of the trainers.

           TSMU Department of Odontology  expresses its readiness to share experiences with interested parties       info@unident.ge

Summary of Work

   There are   644 students at TSMU Faculty of Stomatology. At present, the number of students at the Department of Odontology is as follows: III Semester 142 students, IV semester 142 students, VI semester 116 students, VII semester 102 students, X semester 126 students.

   As noted above, 5-10 years ago, examination of the former Department of Dentistry (now the Department of Dentistry) were carried out in accordance with the rules adopted and established in the former Soviet Union. Consequently, the results pointing to an objective assessment of students in most cases have not been adequate.

   Below you can see the schemes of the exam results at the Department of Odontology on the base of the rule obtained before (2005, 2006, 2007, 2008) and after (2009, 2010, 2011, 2012) Objective structured clinical examination (OSCE).

 

Summary of Results

    The results obtained after Objective Structured Clinical Examination (OSCE) revealed that every next semester the students apply much more sophisticated and refined clinical skills for patient’s examination and treatment. 

Acknowledgement

   Special Thanks to Nini Svanishvili M.D. and Vadim Agaiani for invaluable support and help in creation E-Poster

   The authors express their deep gratitude to the administration of Tbilisi State Medical University for the opportunity to participate in a conference organized by the  Association for Medical Education  in Europe (AMEE).

    The authors express their sincere gratitude  to Oslo,s University Professor Babbil Stray-Pedersen, who is the one of the first authors and faunder of OSCE system. Tbilisi State Medical University,s professors appreciate his great afford in our trainings and cooperation.

References

All the references are listed in the details

Background

   Only 5-7 years ago, at the Department of Odontology the exams were carried out in accordance with the rules adopted and established at the former Soviet Union (so called ticket-system). It should be emphasized that the mentioned style is still preserved in some higher education schools (Institutes and Universities). According to the existed data academic staff (Professors) was able to evaluate only students’ theoretical knowledge not their clinical competencies/skills. Actually, patients’ examination, diagnostic and especially treatment were practically impossible.

   The OSCE is particularly designed for odontology to assess the students’ objective knowledge. 

   TSMU Department of Odontology incorporates 2 directions: Operative Odontology and Endodontics. Each of them includes the teaching of three subjects.

   Course of  Operative Odontology:

   III semester - Preclinical Operative Odontology (2 credits)

   VI semester - Propedevtics of clinical Operative Odontology (4 credits)

   X semester – Clinical Operative Odontology (5 credits)

   Course (division) of  Endodontics:

   IV semester - Preclinical Endodontics  (3  credits)

  VII semester - Propedevtics of clinical Endodontics  (4 credits)

   X semester – Clinical Endodontics    (4 credits)

   OSCE - type exam should be carried out after completion of the each subject separately. After completion of each semester the exam performance style is equal. 

   OSCE - type of examination should be conducted immediately after completion of each subject course. At the end of each semester exam performance style is the same.

   Step I of the exam in the III and IV semesters is devoted to demonstration of clinical skills/competencies.  Individual working place where the student will be able to demonstrate task performance (duration 30 min.) should be determined for every student separately.

   Quality of clinical skill performance should be assessed by criteria where each of them is allocated relevant scores,   amount of which will be equal to the final score at step I of the exam (clinical skills). Step II includes test-exam (duration 30 min.) but step III - reading the  illustrated data, respectively.

http://www.youtube.com/watch?v=vR7OCxYhuY8&feature=youtu.be

   Total score for all three steps equals to 40 which is the maximal exam score. 

   Actually, the OSCE exam won’t be effective and objective unless the student prepares for it during the semester time. Therefore, at the Department of Odontology, development of clinical skills during the semester should be paid much attention. At each semester the student should assimilate a certain number of manipulations (III Semester 80 manipulations, IV Semester 60 manipulations, VI Semester 30 manipulations, VII Semester 28 manipulations, X Semester 13 (6+7)  manipulations). The list of mentioned manipulations will be given in student’s diary of practical activities and each manipulation should be carried out under the direct supervision of academic staff/Professors consequently accumulating the scores on the base of the quality of clinical skill performance.

Example:

   In the IV semester (Phantom Endodontics) at practical lesson the student should perform 60 endodontic clinical manipulations corresponding to 40 scores (100%). 56-59 manipulations correspond  to   35 scores, 51-55 manipulations to 30 and 46-50 manipulations - 20, respectively.

   Assimilation of clinical skills should be added the indexes of student’s theoretical knowledge, and lecture attendance and finally, the index of students’ learning outcomes for the semester,   permitting them to the final exam, will be determined. And the exam at it was mentioned above will be held on the base of  OSCE type.

Conclusion

 

 

   At TSMU Department of Odontology the OSCE exam has been held since 2009; the experience gained for that period of time showed that: 

·            First of all the process of examination was not stressful for the students of III, IV, VI and VII semesters. It should be noted that in case of face to face examination, the student's reaction might be inadequate, due to feeling discomfort to reveal his / her knowledge properly.

            Every student was given the opportunity to reveal versatile skills:

                         1. Clinical skills/competencies and  manual-work;

                         2. Discussion and analysis of simulated clinical situations;

                         3. Collection of patient's medical history and diagnostical skills;

                         4. Identification of different morphological and histological preparations and their relation with any          

                             specific diseases.

·            It should be noted that finally each result will be considered and announced publicly, so the OSCE examination means the certain  publicity as well;

·            And finally, the OSCE-type of the examination provides maximum objectification for knowledge assessment, as for one examination day only one exam situation will be foreseen (the same exam-questions for all students) so that all students will be maximally isolated from each other.

        By the way it should be emphasied that in future the Department will pay more and more attention to the assessment of students' theoretical knowledge and developed independent work, as the accent made on improvement of practical/clinical skills revealed some shortcomings in this field.   

Take-home Messages
Summary of Work
Summary of Results

 

 

 

 

 

    The results obtained after Objective Structured Clinical Examination (OSCE) revealed that every next semester the students apply much more sophisticated and refined clinical skills for patient’s examination and treatment. 

   In previous years (2005 - 2008) some scare and lack of knowledge the students showed at handling the clinical manipulations resulted in creation problems for their clinical activity.

   In addition, it should be emphasized that only a theoretical knowledge will be insufficient to prepare students for the faculty of stomatology. This is a very practical field of medicine and, therefore, the development of learning activities in this direction would be very important for the future stomatologist.

Acknowledgement
References


  •    Steven Marwaha -Objective Structured Clinical Examinations (OSCE) psychiatry and Clinical assessment of Skills and Competencies (CASC) Same Evidence,Different Judgement -BMC Psychiatry 2011,11:85

 

  • Hurley K.F. OSCE and clinical skills handbook. 2011 . Elsevier Sounders

 

  • Dent J.A. ,Harden R.M.  A practical guide for medical teachers.2009. Pp. 334-340.

 

  • Cannick G.F., Horowitz A.M., Garr  D.R. et al. Use of the OSCE to Evaluate Brief Communication Skills Training for Dental Students. Journal of Dental Education ,2007, Vol.71, No 9,pp. 1203-1209

 

  •  Jeremy Wallace, Ranga Rao and Richard Haslam - Simulated patiens and objective structured clinical examinations: review of their use in medical education- Advances in Psychiatric Treatment (2002, v 8) p. 342-348

 

  • N. Ananthakrishnan-  objective structured clinical/practical examinations (OSCE/OSPE) - Journal of Postgraduate Medicine , 1993, v.39 p.82-84

 

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